Midterm Exam CP II

biopsychosocial model

biopsychosocial model

an individual’s health status is determined by the interplay of the person’s status in the biological, psychological, and social domains

ICF model

used to describe the patient’s state of illness and disability, helps to classify the components and magnitude of the patient’s level of health, and provides a standard language and framework that enables the collection of data for practice and research; how we describe a person and their lived experience

health condition

an individual’s involved pathology, disorder or disease process

body functions and structures

an individual’s anatomic and physiologic features of the body

impairments

an individual’s specific problem area or abnormality likely associated with the health condition

activities

the specific tasks and actions executed by the individual

limitations

constraints in performance of functional tasks

participation

an individual’s involvement in life situations like socially defined roles

restrictions

limited ability to participate - often related to socially defined roles

contextual factors

the entire background of an individual’s life and living situation and it’s broken into environment and personal factors

environmental factors

involves factors associated with the physical, social, and attitudinal environment that affect the experiences of an individual; example: having access to a vehicle or having stairs

personal factors

involves features of the individual that are not part of the health condition (such as age, race, gender, lifestyle habits, etc.); stress, anxiety, and mental health fall into this category

best available evidence, clinical expertise, and patient or client values and circumstances

the three components of evidence-based practice

examination, evaluation, diagnosis, prognosis, intervention, outcomes

the six elements of the patient/client management model

examination

gather data

evaluation

correlate/interpret data

diagnosis

label for an impairment

prognosis

level of change; time frame

intervention

treatment/plan of care/interaction

outcomes

measured before and after (baseline vs. post intervention)

history (outcome measures and review of systems), systems review, and special tests and outcome measures

the three major components of the PT examination

history

part of PT examination that is subjective and most of the information comes directly from the patient; it is a systemic gathering of data both past and present related to why the patient is seeking PT services

outcome measure

measures baseline performance, quantifies change, and provides information on effectiveness of interventions; can be general or specific to body region, health condition, or the individual; can be both objective and subjective depending on the type of data collected

self-report

a type of outcome measure that requires the patient to complete a standard form or survey; limitation: patient may choose more favorable answers rather than responding with the truth (survey bias)

performance-based test

a type of outcome measure that involves clinician observation of a patient during the performance of an activity to assess what a patient can do under very specific (controlled) circumstances

review of systems

this is a component of the history-gathering phase in which the clinician seeks info about all major body systems; it is a subjective screen that can be done as a chart review, intake form, or patient interview

signs of serious pathology, cauda equina, fracture, tumor, sudden weight loss, unremitting pain

red flags found during the history and review of systems that indicate a patient should be referred

psychological risk factors (depression, anxiety, and unhelpful beliefs about pain), social and environmental risk factors (belief activity will hurt them/fear avoidance behaviors), coping strategies

yellow flags found during the history and review of systems that indicate the clinician should proceed with caution during treatment

hypothesis and patient function

what should guide the PT objective exam

during and at the end of the subjective exam - after history and review of systems

when should a PT begin generating hypotheses

red flags, yellow flags, intake/other questionnaires, outcome measures, and PT related impairments

what should be considered when generating a hypothesis

screening is more general (abnormal vs normal); special testing is more specific to the problem

difference b/t screening and special testing

systems review

an objective screening that involves a brief, limited examination; likely involves the screening of cognition/communication, cardiopulm system, integumentary system, GI and genitourinary systems, musculoskeletal system, neuromuscular system, or functional mobility

PT diagnosis, prognosis, goal setting, plan of care (interventions), and outcomes

the five major components of the PT evaluation

PT diagnosis

component of PT evaluation that is a label to identify the impact of a condition on function at the movement system level; this is the primary dysfunction of the physical therapy intervention

muscle performance, cardiopulmonary/endurance, mobility/flexibility, neuromuscular control/coordination, stability, balance/postural equilibrium, and pain

the seven impairment categories

muscle performance

impairment category in which the patient has impaired AROM but full PROM, would test using a MMT, and patient would report feeling weak/limbs feeling heavy

balance/postural equilibrium

impairment category that involves the patient having repeated falls, stumbling, using assistive devices, or holding onto walls/furniture

stability

impairment category that involves physiological instability at the joints or structural integrity issues, patient may have dislocations/subluxation, hypermobility, or osteoporosis

neuromuscular control/coordination

impairment category that indicates the brain is disconnected from the muscles, muscle coordination and muscle activation are affected; could be caused by stroke, SCI, Parkinson’s disease, etc.

mobility/flexibility

impairment category that involves PROM issues and tightness; would be assessed using goniometry or inclinometry

pain

this impairment category can influence all other categories and could potentially mask the primary impairment/hides the root cause of the problem

cardiopulmonary/endurance

impairment category in which the patient experiences shortness of breath, abnormal vitals signs, and fatigues fast; patient could report having a history of cardiac or pulmonary problems or could be diagnosed with cardiac or pulmonary disorders (poor circulation related to CVD could potentially be put in this category)

prognosis

component of the PT evaluation that uses evaluation results, pre-existing and current health status, and psychosocial factors to predict the optimum level of improvement on function and the predicted amount of time needed to reach that level

mobility/flexibility definition

the ability to move a single joint or series of joints smoothly and easily through an unrestricted, pain free ROM

contracture, prolonged immobilization, sedentary lifestyle, postural asymmetry or malalignment, dysfunctional neuromuscular control

factors that may contribute to hypomobility

functional excursion

term for the distance from max elongation to max shortening

active insufficiency

term for the point at which the agonist muscle can no longer shorten

passive insufficiency

term for the point at which the antagonist can not be elongated without damage

PROM

term for motion produced by an external force (no muscle contraction)

AROM

term for motion produced directly by contraction of muscles (agonist)

active-assistive ROM (AAROM)

term for motion produced by both contraction of muscles (agonist) and external force

establish limitations of motion, determine joint mobility and end-feel, evaluate flexibility of soft-tissue structures, determine patient’s level of reactivity, assists with determination of patient’s irritability

indications for PROM exam

establish limitations of motion, evaluate flexibility of soft-tissue structures, begin the process of establishing the patient’s strength (mm performance), assists with determination of patient’s irritability

indications for AAROM and AROM exam

when mm contraction or motion of the body part could disrupt the healing process or could cause injury or deterioration of the condition

contraindications for ROM exam

painful conditions, patient taking pain medications or mm relaxants, osteoporosis/bone fragility, hypermobility, hemophilia, in a region of a hematoma (especially in knee, hip, and elbow), bony ankylosis, after injury where soft tissue is disrupted, region of recently healed fx

precautions for ROM exam

AROM

gross ROM exam that is tested first and involves quantity (ROM), quality (performance and willingness to move), and irritability (symptom provocation and time for recovery)

PROM

gross ROM exam that is tested second and involves quantity (ROM), quality (end feel), reactivity (determining when symptoms are provoked), irritability (symptom provocation and time for recovery), and tone assessment (if indicated)

hard end-feel

end feel created by bone-to-bone contact

firm end feel

end feel created by muscular, capsular, or ligamentous stretch

soft end feel

end feel created by soft-tissue approximation

empty end feel

abnormal end feel that indicates the end of ROM was not reached due to pain/fear/anxiety/etc.; no resistance is felt except for the patient’s protective mm guarding or mm spasm

reactivity

this is documented as reports of pain

high reactivity

this is reports of pain prior to the therapist encountering end feel

moderate reactivity

this is reports of pain as the therapist encounters the beginning of the end feel

low reactivity

this is reports of pain as the therapist has encountered full range and end feel

irritability

this is documented as a patient’s level of symptom provocation and time for recovery; the vigor of activity required to provoke symptoms and the time it takes for those symptoms to subside once aggravated

maximal irritability

ratio of 1:2 or greater of aggravating activity to easing activity or rest; very little tolerance to activity and require significant time/effort to recover

moderate irritability

ratio of 1:1 of aggravating activity to easing activity or rest; moderate tolerance to activity, may increase symptoms that return to baseline with periods of rest or relieving motions of the same length of time as it took to bring symptoms on

minimal irritability

ratio of at least 2:1 of aggravating activity to easing activity or rest; high tolerance to activities, many repetitions or able to sustain a posture for a long time before symptoms appear, symptoms ease quickly with stopping activity or changing positions

functional

ultimately, it is __________ movement patterns that should direct clinical decision making

strength, power, and mm endurance

the three factors that contribute to muscle performance

strength

this is the ability of contractile tissue to produce a force

power

this is the ability to work per unit of time

muscle endurance

this is the ability to work over extended periods of time

when mm contraction or motion of the body part could disrupt the healing process and when mm contraction or motion of the body part could cause injury or deterioration of the condition

the two key contraindications for mm performance exams

5

MMT grade: antigravity, full movement + tolerates strong pressure

4

MMT grade: antigravity, full movement + tolerates moderate pressure

3+

MMT grade: antigravity, full movement + tolerates some/minimal pressure

3

MMT grade: antigravity, full movement only

3-

MMT grade: antigravity, movement > ½ and < full

2+

MMT grade: antigravity, movement < ½ full range

2+

MMT grade: gravity eliminated, movement = full range + tolerates some pressure

2

MMT grade: gravity eliminated, movement = full range

2-

MMT grade: gravity eliminated, movement < full range

1

MMT grade: any, palpable contraction

0

MMT grade: any, no mm contraction

function

what is the primary focus of all therapeutic interventions

SAFETY, primary impairment category, ICF model, HIAPEP, evidence based practice, body mechanics, factors regarding person, task, and environment, SAFETY

these are the general principles in therapeutic intervention

environment, intertrial variability, body, and manipulation

the four key components of Gentile’s Taxonomy

>2-3 days/week with daily the most effective (3-4 weeks of regular training required

FITT dosing: stretching frequency

stretch to the point of resistance/tightness/slight discomfort

FITT dosing: stretch intensity

10-30 sec reps for most adults that should add up to at least 1 min of total stretch time, 30-60 sec reps for older adults

FITT dosing: stretch time

static, ballistic, PNF, passive, assisted, etc.

FITT dosing: stretch type

1-RM test

test used to establish a baseline mm performance; it is used for dosing

Borg’s Scale or Modified Borg Scale (RPE)

this is used as an alternative to the 1-RM test to gauge exercise intensity

rest intervals: 30-90 sec b/t each set, recovery: 48 hr b/t training sessions

recommended rest interval and recovery for strength training

rest interval: 2-5 min b/t each set, recovery: 48 hr b/t training sessions

recommended rest interval and recovery for power training

rest interval: <30 sec b/t each set, recovery: 48 hr b/t training sessions

recommended rest interval and recovery for endurance training

functional

Maximize performance and order of exercises targeting primary __________ goal